By Kirstie Perrotta, MPH and Sonia Alvarado, MotherToBaby California
With wildfires seemingly becoming a year-round problem, pregnant women have more questions than ever about smoke exposure and lingering poor air quality. Understanding the potential risks of a fire during pregnancy or while breastfeeding can help people make informed decisions when the unthinkable happens. Here are some common questions we get at MotherToBaby about fires.
Q. What is in the air from the fires?
A fire produces particulate matter (a combination of dirt, soil dust, pollen, mold, ash, and soot), among other chemicals. Particles can have different sizes. Particles smaller than 10 micrometers in diameter pose the biggest problems because they can get deep into your lungs and some may even enter your bloodstream. Smoke content can vary depending on what is being burned. In some cases, fire smoke may contain heavy metals such as lead. Fire smoke also contains carbon monoxide.
E. I am pregnant. How do particles affect my pregnancy? What about carbon monoxide?
Experts tell us that the smaller the particles, the worse the health effects, such as difficulty breathing, worsening asthma and an increased risk of heart attack and death from respiratory and cardiovascular problems. Although we don’t know enough about how exposure to particulate matter can affect a pregnancy, it makes sense for everyone to take extra precautions to reduce their exposure to wildfire smoke.
Carbon monoxide is a gas that enters the lungs and blood and displaces oxygen in both mom and baby. The greater the exposure and the greater the exposure, the greater the risk. Studies show that there may be a higher chance of birth defects when a woman is exposed to carbon monoxide in the first trimester, but more studies are needed. Other studies have found that exposure to wildfire smoke can increase the risk for premature birth and low birth weight. However, this finding may be more related to the stress a woman experiences during a fire or a combination of factors than to actual smoke exposure. Again, more research is needed.
Q. I have asthma and I’m pregnant. Do I have additional risks?
Yes. Studies in non-pregnant people tell us that exposure to particles 10 micrometers in diameter or smaller can worsen asthma symptoms. Pregnancy would not protect you and may even put you at a higher risk of having an asthma attack depending on how far along you are. See our asthma newsletter here.
Depending on your proximity to the fire zone, it may be difficult to get help if your symptoms worsen. First responders may be busy fighting fires and evacuating residents and may not get to you as quickly as you need. Emergency rooms may be overbooked. For this reason, it is very important to always carry your asthma medication with you so that if smoke worsens your symptoms, you can start treating yourself. You also want to be in touch with your doctor and get away from the source of the fires as soon as possible.
E. I am pregnant and working outdoors. Do I need a mask?
The US Environmental Protection Agency (EPA) has recommendations about which masks you should use to protect against particles that enter the lungs. The goal is to prevent or reduce exposure as much as possible. If you work indoors, you are mostly protected. If you work outdoors, you may want to use a mask that fits properly and has two head straps to hold it in place. It should be labeled “particulate respirator” and should be tested or approved by the National Institute for Occupational Safety and Health (NIOSH). Learn more here. Since pregnancy can change how your lungs work, pregnant women may have trouble breathing at first. For this reason, it is important to contact your healthcare provider before using a particulate respirator.
If you are concerned about your working conditions, NIOSH offers a program called the Health Hazard Assessment Program. This program helps workers learn if there are health risks in their workplace and recommends ways to reduce risks and prevent work-related illnesses. Learn more here.
Q. I live about 50 miles from the fires. Do I still need to worry about being outdoors?
Depending on where you live and the wind direction, the air quality in your area may be poor because of the fire, even if the fire is not that close to you. Listen to local health and environmental officials and avoid exercising outdoors, gardening, or performing other activities that may cause you to exercise and inhale more of the particles in the air. If in doubt, wait until the fires are out and the air quality is back to normal.
Q: Can wildfires cause other problems for pregnant women?
Depending on the weather, fires can spread quickly. The stress of having to make life and death choices, or the decision to leave your home and decide which items to take on very short notice, all cause tremendous stress. It is perfectly normal to feel sad, anxious, stressed or afraid. In pregnancy, depending on how long the stress has been present and the level of stress, there are likely to be effects on the developing baby, so anything you can do to try to reduce stress is always a good idea. Check out our stress newsletter for more information:
Q: I am pregnant. What if I have to evacuate?
The best thing you can do is have a plan ahead of time. Make a list of items to take with you if you need to evacuate your home. Assemble one emergency supply kit and store it in a location where you can easily get to it and create a family communication plan.
When it’s time to evacuate, stay calm. Make sure you have all the medicines you take on a daily basis (including your prenatal vitamins) with you. Stay well hydrated, keep eating and rest as much as you can. If you must go to a shelter, tell the staff there that you are pregnant so they can make the necessary arrangements.
While going to your prenatal check-up is probably the last thing on your mind in the middle of discharge, it’s important to keep seeing your doctor/gynecologist or midwife. Some people may be displaced from their homes for a long time, however, it is important to keep up with your prenatal care visits to make sure the baby is growing and developing properly.
If you are nearing your due date, check to make sure your hospital or birthing center is not in the mandatory evacuation zone. If it is near the fires, staff and patients there may be asked to evacuate and you may need to deliver it to a different hospital. Knowing this information before you go into labor will reduce any unnecessary stress.
Q: What other steps can I take to minimize my exposure to fire smoke?
Stay indoors when possible and keep your windows and doors closed. If available, an air purifier can help with indoor air quality. If you must drive somewhere, keep your windows rolled up and use the air conditioner to stay cool. If your car has a button that recirculates the air inside, make sure it’s turned on. Pregnant women who must go outdoors may also consider wearing a mask. While any protection is helpful, an N95 particulate respirator works best to filter out harmful particles.
E. I am breastfeeding and worried about the fires in my area
Nursing mothers can also face their own challenges when they have to evacuate their homes. When possible, follow the steps outlined above to reduce fire smoke exposure for both you and your baby.
The benefits of breastfeeding are well known and in most cases people are encouraged to continue breastfeeding their babies even when faced with an emergency such as a fire. People who are breastfeeding should focus on staying well hydrated and continue to feed the baby when asked.
For mothers who choose to pump, extra batteries may be worth packing in your emergency supply kit in case the power goes out. For formula-fed babies, it is important to have bottled water with them.
Q: Where can I learn more about the fires currently happening and the air quality where I live?
The US Department of Agriculture (USDA) Forest Service reports of major wildfires nationwide. The EPA also has a website where you can check the air quality index in your area. Pregnant women should follow the instructions provided for “susceptible people”. Finally, the Centers for Disease Control and Prevention (CDC) has more helpful information about fire exposure during pregnancy here.
